The document discusses the use of lasers in periodontics, including for treating dentinal hypersensitivity, non-surgical periodontal therapy, and surgical therapy. It summarizes the different types of lasers used, such as low-level lasers for biostimulation, Nd:YAG and diode lasers for bacterial reduction, and Er:YAG lasers for calculus detection and removal with minimal thermal damage to tooth surfaces. The document reviews studies on the effectiveness of lasers for calculus detection and removal, bacterial reduction, detoxification of root surfaces, and biostimulation effects with low-level laser therapy.
INTRODUCTION
HISTORY
PRINCIPLES OF WORKING OF A LASER
FUNDAMENTALS OF LASER
CHARACTERISTICS OF LASER
CLASSIFICATION OF LASER
EFFECTS OF LASER ON SOFT AND HARD TISSUES
VARIOUS LASERS AVAILABLE FOR PERIDONTAL USE
APPLICATION OF LASER TREATMENT IN PERIODONTAL THERAPY
ADVANTAGES & DISADVANTAGES OF LASER IN PERIODONTAL THERAPY
LASER PRECAUTIONS
LASER HAZARDS
RECENT ADVANCES
CONCLUSION
This lecture reviews the role of laser therapy in dentistry in particular for Periodontal treatment. Dr. Smith reviews many of his own cases with the audience.
Please contact Dr. Smith with questions.
drsmith@cpident.com
INTRODUCTION
HISTORY
PRINCIPLES OF WORKING OF A LASER
FUNDAMENTALS OF LASER
CHARACTERISTICS OF LASER
CLASSIFICATION OF LASER
EFFECTS OF LASER ON SOFT AND HARD TISSUES
VARIOUS LASERS AVAILABLE FOR PERIDONTAL USE
APPLICATION OF LASER TREATMENT IN PERIODONTAL THERAPY
ADVANTAGES & DISADVANTAGES OF LASER IN PERIODONTAL THERAPY
LASER PRECAUTIONS
LASER HAZARDS
RECENT ADVANCES
CONCLUSION
This lecture reviews the role of laser therapy in dentistry in particular for Periodontal treatment. Dr. Smith reviews many of his own cases with the audience.
Please contact Dr. Smith with questions.
drsmith@cpident.com
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
Gingivectomy means excision of the gingiva.
Gingivoplasty is a reshaping of the gingiva to create physiologic gingival contours with the sole purpose of recontouring the gingiva in the absence of pockets.
Smoking and periodontal disease, smoking as a risk factor, incidence of smoking, effects of smoking on periodontium, smoking and gingivitis and smoking and periodontitis, effect of surgical and non surgical therapy on smokers
Every periodontal surgical procedure has its own indications. With proper knowledge of the etiology of the disease, correct diagnosis and treatment planning, the clinician is able to draw predictable success with periodontal flap surgery.
Surgical v/s Non surgical periodontal therapy Achi Joshi
Both surgical and nonsurgical therapy produced improvement in the periodontal health.
Treatment approach was based on the comfort level of the practitioner.
In the late 60’s and continuing into the 70’s and 80’s, many series of longitudinal studies were conducted, aimed to document the immediate and most importantly long term clinical results following several types of periodontal therapy.
Gingivectomy means excision of the gingiva.
Gingivoplasty is a reshaping of the gingiva to create physiologic gingival contours with the sole purpose of recontouring the gingiva in the absence of pockets.
Smoking and periodontal disease, smoking as a risk factor, incidence of smoking, effects of smoking on periodontium, smoking and gingivitis and smoking and periodontitis, effect of surgical and non surgical therapy on smokers
Every periodontal surgical procedure has its own indications. With proper knowledge of the etiology of the disease, correct diagnosis and treatment planning, the clinician is able to draw predictable success with periodontal flap surgery.
LASERS – IT’S ROLE IN PERIODONTAL REGENERATIONhiij
The use of lasers has evolved as clinical experience along with scientific investigation. The dental
lasers of today have benefited from decades of laser research and have their basis in certain
theories from the field of quantum mechanics. When used efficaciously and ethically, lasers are an
exceptional modality of treatment for many clinical conditions that dental specialists treat on a
daily basis. The concept of using lasers for the treatment of periodontal disease elicits very strong
reactions from all sides of spectrum. Evidence suggests that lasers are useful as an adjunct or
alternative to traditional approaches in periodontal therapy. Future direction of lasers would be
towards a minimally invasive regenerative procedures along with laser assisted calculus detection
systems using laser fluorescence that is optical coherence tomography and a laser system which
selectively and completely removes the plaque and calculus that is under development. With recent
advances and development of wide range of laser wavelengths, different instrument designs and
different delivery systems, the purpose of this review is to determine the application and current
concept of lasers in the regeneration of periodontal tissues.
LASERS – IT’S ROLE IN PERIODONTAL REGENERATIONhiij
The use of lasers has evolved as clinical experience along with scientific investigation. The dental
lasers of today have benefited from decades of laser research and have their basis in certain
theories from the field of quantum mechanics. When used efficaciously and ethically, lasers are an
exceptional modality of treatment for many clinical conditions that dental specialists treat on a
daily basis. The concept of using lasers for the treatment of periodontal disease elicits very strong
reactions from all sides of spectrum. Evidence suggests that lasers are useful as an adjunct or
alternative to traditional approaches in periodontal therapy. Future direction of lasers would be
towards a minimally invasive regenerative procedures along with laser assisted calculus detection
systems using laser fluorescence that is optical coherence tomography and a laser system which
selectively and completely removes the plaque and calculus that is under development. With recent
advances and development of wide range of laser wavelengths, different instrument designs and
different delivery systems, the purpose of this review is to determine the application and current
concept of lasers in the regeneration of periodontal tissues.
LASERS – IT’S ROLE IN PERIODONTAL REGENERATIONhiij
The use of lasers has evolved as clinical experience along with scientific investigation. The dental lasers of today have benefited from decades of laser research and have their basis in certain theories from the field of quantum mechanics. When used efficaciously and ethically, lasers are an exceptional modality of treatment for many clinical conditions that dental specialists treat on a daily basis. The concept of using lasers for the treatment of periodontal disease elicits very strong reactions from all sides of spectrum. Evidence suggests that lasers are useful as an adjunct or alternative to traditional approaches in periodontal therapy. Future direction of lasers would be towards a minimally invasive regenerative procedures along with laser assisted calculus detection systems using laser fluorescence that is optical coherence tomography and a laser system which selectively and completely removes the plaque and calculus that is under development. With recent advances and development of wide range of laser wavelengths, different instrument designs and different delivery systems, the purpose of this review is to determine the application and current concept of lasers in the regeneration of periodontal tissues.
Laser science is principally concerned with quantum electronics, laser construction, optical cavity design, the physics of producing a population inversion in laser media, and the temporal evolution of the light field in the laser. It is also concerned with the physics of laser beam propagation, particularly the physics of Gaussian beams, with laser applications, and with associated fields such as non-linear optics and quantum optics.
THE TREATMENT OF INFECTIONS ON TOOTH SURFACES AND IN ROOT CANALS WITH THREE DIFFERENT LASER MODALITIES: Photodynamic Therapy, Photothermal Therapy, Photoablation
INTRODUCTION OF LASERS IN ORAL AND MAXILLOFACIAL SURGERY
INITIAL USE IN ORAL AND MAXILLOFACIAL SURGERY
CHARACTERISTICS OF LASER LIGHT
CLASSIFICATION OF LASERS
TISSUE INTERACTION
TYPES OF LASERS
ADVANTAGES AND DISADVANTAGES
LASER SAFETY IN SURGERY AND ANESTHESIA
PATIENT SELECTION
APPLICATIONS
SURGICAL LASER TECHNIQUE
APPLIED ASPECTS
RECENT ADVANCES
COMPLICATIONS
The use of lasers in dentistry, particularly in periodontics and peri-implant diseases, is becoming
increasingly common nowadays. Since their introduction in the late 20th century, they have revolutionized the
treatment options available for the management of periodontal disease. They allow the clinician to reach inside the
deeper pockets and help in reducing the bacterial load. They offer various advantages and have variations according
to their clinical use. This review presents an overview of their applications in periodontics.
Aim: This review aims at opening the clinical professionals eyes to various possibilities for the usage of laser that is innovative skill in the field of periodontics. Background: There is no doubt regarding clinical application of laser, but for best management and for effective clinical protocols literature should be supported by basic and clinical research and evidence. Review Results: In this review there is a collection of data from scientific papers clinically relevant to the periodontitis providing description of parameters of lasers, its effect on soft tissue, history of use laser in periodontics in particular as well as various use of laser in the field of periodontics .Conclusion: Laser is a promising auxillary tool in periodontics but further evidence is required to have effective clinical effect. Clinical Significance: Less of thermal damage, less bleeding and uneventful healing is the clinical significance of laser when used on soft tissues.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. Contents : Session II
Introduction
Lasers in dentinal hypersensitivity
Lasers in non surgical therapy
Lasers in surgical therapy
Lasers in implants
Photodynamic therapy in laser
Effects of lasers on periodontal therapy
Conclusion
References
3
4. Introduction
■ Lasers has emerged in recent years as a noninvasive therapeutic
modality for the treatment of various infections & conditions.
■ In periodontics, laser is beginning to emerge as one of the
important armamentarium for future generations. On day to day
basis, laser is being more & more preferred for minor procedures.
4
5. Lasers in dentinal hypersensitivity
■ Que et al. pointed out a prevalence of DH varying between 2%–8% and
74%.
■ In patients affected by periodontitis, DH prevalence was even higher
ranging between 60% and 98%, this condition may affect patients at
any age, and both genders are equally affected.
■ Laser therapy was first introduced as a potential method for treating
DH in the mid-1980s.
5
6. ■ Low-level laser therapy (LLLT) is a sensitizing method that shows promise.
This treatment induces alterations within the net of nerve transmission of
the dental pulp, instead of altering the exposed dentinal surface, as in most
other types of treatment.
■ LLLT has been used for DH since the 1980s. Studies using the gallium
aluminum arsenide (GaAlAs) laser showed DH reduction in the range of
60%–98%.
6
8. Treatment of dentinal hypersensitivity by Lasers : A review
Kimura Y et al. JOCP 2000, 27 ; 715 - 721
To date 4 different types of laser have been used for hypersensitivity; to check
the effectiveness .
Low output lasers / low level lasers : He Ne laser, GaAlAr (diode) laser
Middle output laser : Nd YAG laser , CO2 laser
8
11. Combination of laser t/t with fluoride
■ There have been reports that NaF (Lin and Lan 1994) and SnF2 (Moritz et al
1996, 1998) effectiveness is enhanced when used with fluoride.
■ Combined use of GaAlAr laser (830 nm) with fluoride enhances the t/t
effectiveness by 20 % over laser t/t alone.
■ In an invitro study, most dentinal tubules orifices were occluded after t/t by Nd
YAG laser irradiation followed by topical NaF (Lan et al 1999)
11
12. Considerations regarding laser t/t of
dentinal hypersensitivity
■ Placebo effect : the cumulative effect of any therapy to provide gradual
improvement on every visit.
■ A strong placebo effect is seen in c/l trials of CDH.
■ Effect consist of a complex mixture of doctor patient r/l, with both parties
needing to believe that t/t is valuable and desiring to obtain relief of
symptoms.
■ Investigators reported of relief of pt’s without any t/t due to placebo effect
vary from 20 to 60 % in c/l trials. (West et al 1997)
12
13. Non surgical therapy
primarily aimed at efficient removal of plaque, calculus &
reduction of bacterial load, inflammation
Conventional therapy limitations:
• incomplete removal of calculus
• incomplete elimination of inflamed pocket lining.
• Lasers used : Diode lasers, ND:YAG, ER:YAG & CO2 lasers
13
14. 36. Buchanan SA, Robertson PB. Calculus removal by scaling and root planing with and without surgical
access. J Periodontol 1987;58: 159–163
38. Rabbani GM, Ash MM, Caffesse RG. The effecti veness of subgingival scaling and root planing in calculus
removal. J Periodontol 1981;52: 119–123.
39. Gellin RG, Miller MC, Javed T, Engle WO, Mishkin DJ. The effectiveness of the Titan-S sonic scaler versus
curettes in the removal of subgingival calculus. A human surgical evaluation. J Periodontol 1986;57: 672–
680.
40. Brayer WK, Mellonig JT, Dunlap RM, Marinak KW, Carson RE. Scaling and root planing effectiveness: the
effect of root surface access and operator experience. J Periodontol 1989;60: 67–72.
41. Clifford LR, Needleman IG, Chan YK. Comparison of periodontal pocket penetration by conventional
and microultrasonic inserts. J Clin Periodontol 1999:26: 124–130.
42. Carey HM, Daly CG. Subgingival debridement of root surfaces with a micro-brush: macroscopic and
ultrastructural assessment. J Clin Periodontol 2001;28: 820–827.
43. Kawanami M, Sugaya T, Kato S, Iinuma K, Tate T, Hannan MA, Kato H. Efficacy of an ultrasonic scaler with
a periodontal probe-type tip in deep periodontal pockets. Adv Dent Res 1988;2: 405–410.
45. Lee A, Heasman PA, Kelly PJ. An in vitro comparative study of a reciprocating scaler for root surface
debridement. J Dent 1996;24: 81–86
14
15. Subgingival calculus detection – unique
application for lasers
Conventional methods : tactile sensation
Recent : ER:YAG lasers with fluorescent feedback system for calculus
detection
Rationale :
Difference of fluorescence emission properties of calculus and dental
hard tissues when subjected to irradiation with 655nm diode laser.
15
17. Author & yr Study design Objective Findings
Folwaczny M et al
2002
In vitro –
extracted teeth
assess efficacy of
fluorescence induced by 655
nm diode laser to detect
subgingival calculus
655 nm diode laser
effective for calculus
detection
Krause F et al 2003
Invitro –
histologic study
(in presence of
saline/ blood)
Efficacy for calculus
detection
Laser fluorescence
value co-relate
strongly with calculus
presence
Scharwz F et al
2003
In- vivo & vitro.
Er YAG with diode
655nm combined
Compare the new system
with SRP for calculus
removal efficacy
Selective removal of
subgingival calculus
Sculean A et al
2004
Er YAG + diode vs
SRP
Improvement of c/l
parameters
Similar results with
both systems
Tung OH et al 2008 Detection through the gingiva - based on autofluoroscnece – Ti sapphire
lasers
17
18. Author &
year
Laser Study design Observation
period
Findings
Cobb et al
1992
Nd YAG Exp (Laser, laser +
SRP, SRP + LASER),
controls
(untreated)
Immediately after
t/t
Low effectiveness of calculus
removal
Decrease in no. of bacteria
Scharwz et al
2003
Diode
Exp (lasers),
Control (SRP)
Immediately after
t/t
Not effective for calculus
removal.
Thermal damages to root
surface
Scharwz et al
2001
Er YAG
Lasers (no
controls)
Immediately after
t/t
Smooth root surface
morphology.
Effective calculus removal
No thermal damage
Scharwz et al
2003
Er YAG with
fluorescent
calculus
detection
system
Exp (lasers)
Control (SRP +
hand scaling)
Immediately after
t/t
Selective subgingival calculus
removal
No thermal damage
Less cementum removal.
18
19. Root surface alterations
Diode laser
Dry or saline moistened root surfaces -
no detectable alterations.
Blood coated specimens – charring
(Kreisler M et al 2002)
Nd YAG laser
Morlock BJ et al 1992: surface pitting,
craters, melting, carbonization of root
surface.
Spencer et al 1992,1996 : decrease in
protein/ mineral ratio, production of protein
by products.
Trylovich DJ eta l 1992: Nd YAG treated root
surface - not favorable for fibroblast
attachment
Thomas D et al 1994 : lasers followed by SRP
– restores the biocompatibility of root
surface
19
20. Root surface alterations
CO2 lasers
• Spencer P , Cobb CM et al 1996 :
Carbonized layer on root surface.
Cyanamide, cyanate ions detected on
carbonized layers – FTIS method
• Gopin BW et al 1997 : char layer
inhibits the periodontal soft tissue
attachment
• CO2 laser contraindicated for root
surface treatment in focused mode.
Erbium lasers
• Aoki et al 2000 : Er YAG with coolant
Micro irregular surface
No thermal effects such as cracking,
fissuring
• Sasaki KM et al 2002 : no major chemical
or compositional change on root
cementum or dentin
• Biocompatibility of root surface: micro-
irregularity offers better attachment to
fibroblasts (Scharwz F et al 2003)
20
21. Bacterial reduction
The only 2 soft tissue wavelengths currently meet the criterion of having a delivery
system able to deliver laser energy efficiently & effectively to periodontal pockets
for NSPT are : Nd YAG and diode
Well abs. by melanin & Hb & other chromophores present in periodontally
diseased tissues. The laser energy is transmitted through water and poorly
absorbed in HA.
21
22. ■ Both of these wavelengths have been shown to be extremely effective
against periodontal pathogens in-vivo & in-vitro (Moritz 1998, Pinhero J
1997)
■ These investigators concluded that the diode laser revealed a bactericidal
effect, helped reduce inflammation, supported healing of the periodontal
pockets through the elimination of bacteria.
22
23. Detoxification studies : basic studies
Author & year Lasers Findings
Misra V et al 1999 CO 2 Smear layer removal
Crepsi et al 2002 CO 2 Root surface decontamination. Favorable for cell
attachment
White JM et al
1991
ND YAG Decontamination of irradiated dentin
Fukuda M et al
1994
ND YAG Inactivation of endotoxin of periodontally
diseased root surface
Ando Y et al 1996 ER YAG High bactericidal activity at low energy settings
Yamaguchi et al
1997
ER YAG Removes LPS diffused into root surface
23
25. ■ 1903 : N.R. Finesen, the father of modern phototherapy, first described low
level UV in t/t of lupus vulgaris.
■ The use of LLLT first initiated in medicine for invitro experiments to determine
the effects on cell cultures & increase blood circulation within regenerating
tissues.
■ Generally smaller, less expensive lasers which operate in the 1-500 milliwatt
range are used. The therapy performed with such lasers is called “LLLT” or
“therapeutic lasers therapy”.
■ The suitable therapeutic energy range is indicated in 1 – 10 joules per point.
25
26. ■ All commercially avl LLT are variants of Ga, Al, Ar which emit in the near
infrared spectrum.
He – Ne laser
Ga, Al, Ar diode laser
Ga - Ar laser
Argon laser
Defocused Nd YAG laser
Defocused CO2 laser
26
27. Biostimulation effects of LLLT
Reduction of discomfort & pain (Kreisler MB et al 2004)
Promotion of wound healing (Qadri T et al 2005)
Bone regeneration (Merli LA et al 2005)
Suppression of inflammatory process (Qadri T et al 2005)
Activation of gingival & pdl fibroblasts (Kreisler M et al 2003), growth factor
release (Saygun T et al 2007)
Alteration of gene expression of inflammatory cytokines (Safavi SM et al 2007)
Photo biostimulation (Garcia et al 2012)
27
28. Laser Assisted New Attachment Procedure
■ LANAP
■ Gold & Villardi 1994, safe application of Nd YAG laser for removal of pocket
epithelium lining without carbonization of the underlying connective tissue.
■ Approved by FDA for use: true regeneration.
■ Yukna et al 2007 – case series – histologic study – new cementum with new
connective tissue attachment on previously diseased root surface.
28
29. 29
1st pass – laser troughing
2nd pass – laser long pass
C E F G HA B D
30. Author & year Laser
used
Study design Observation
period
Findings
Ben Hatit et al
1996 Nd YAG
RCT
SRP + Laser vs SRP
Immediately after 2,6
and 10 weeks
Significantly reduce post
therapy levels of bacteria
following adjunctive laser
Liu et al 1999
Nd YAG
RCT Split mouth study
Laser, laser + SRP (6 wk ltr)
SRP + laser (6 wk ltr)
12 weeks Less effectiveness of laser t/t
in reducing IL-1 ß as compared
to SRP
Miyazaki et al 2003
Nd YAG
RCT
Lasers vs Ultrasonic
1, 4, 12 wks Similar results b/t lasers & US
reduction of P. gingivalis & IL 1
beta levels
Noguchi et al 2005
Nd YAG
Lasers, lasers + local
minocycline, laser +
povidine iodine
1, 3 months Greater reduction of bacteria
on laser + minocycline treated
sites
30
31. Author & yr Lasers
used
Study design Obs . Period Findings
Moritz et al
1997
Diode SRP + Laser
SRP
1, 2 weeks High bacterial reduction in SRP
+ Laser as compared to SRP
sites alone
Moritz et al
1997
Diode SRP + Laser
SRP + H202 rinse
6 months Higher reduction in bacterial,
BOP, PD in SRP + Laser
Kresiler et al
2005
Diode SRP split mouth
SRP + Laser
SRP alone
3 months Greater reduction of PD and
attachment gain in Laser
adjunct sites
Miyazaki et al
2003
CO2 RCT, Laser vs US 1, 4, 12 wks No decrease of Pg and IL 1 in
laser sites, but significant
decrease in US sites
31
32. Author and
yr
Lasers
used
Study design Obs. period findings
Watanabe et
al 1996
Er YAG Case series – Lasers
only
4 wks Safe & effective calculus
removal
Schwarz et al
2001
Er YAG Split mouth design,
RCT (Laser + SRP)
6 months c/l outcome similar to SRP
Sculean et. al.
2004
Er YAG RCT, split mouth (laser
vs US)
6 months c/l outcome similar to US
Tomasi et al
2006
Er YAG RCT, split mouth (laser
vs US)
6 months 1 month following therapy,
laser t/t sites better c/l
outcomes, no difference in
microbiological levels
32
33. Surgical pocket therapy using lasers
■ Lasers used : CO2 and Erbium family
■ use of laser for:
Calculus removal
Osseous surgery
Detoxification of root surface & bone
Granulation tissue removal
Advantages of Laser: Better access in furcation areas, Hemostasis, Less post-op
discomfort and faster healing.
33
34. Author & yr Laser
used
Animal
model
Study objective Findings
Nelson et al 1989 Er YAG Rabbit Immediate tissue
characteristics
Found useful as a bone cutting tool
Lewandrowski et al
1996
Er YAG Rat Cutting efficacy and tissue
characteristics
Comparable thermal damage as
mechanical cut bone. Normal
fracture healing.
Friesen et al 1999 CO2, Nd
YAG
Rat Tissue characteristics Residual carbonized tissue &
thermal necrosis
Sasaki et al 2002 CO2 and Er
YAG
Rat Tissue characteristics Er YAG: tissue removal, no charring.
Two distinct layers. CO2 charring &
no tissue removal.
Stubinger et al 2007 Er YAG human depth control of laser Laser couldn’t offer precise depth
control in prep osteotomies.
34
35. Author & yr Laser used Study design Observation
period
Findings
Centty et al
1997
CO2 laser RCT, split mouth
OFD+ laser vs OFD
alone
Biopsy during
surgery
Laser eliminated significantly
more sulcular epithelium than
conventional surgery
Schwarz et al
2003
Er YAG (for root
conditioning)
RCT + Split mouth,
(OFD + Laser + EMD)
VS (OFD + EMD +
EDTA)
6 months NS difference by using laser for
root conditioning
Sculean et al
2004
Er YAG (granulation
tissue removal)
RCT + split mouth
(OFD + Laser vs OFD
alone)
6 months NS difference between two
groups in c/l outcomes
Gaspire et al
2007
Er YAG (bone
defect irradiation)
RCT, split mouth
Mod Widman Flap +
laser vs MWF
5 years Laser application greater gain in
attachment & pocket depth
reduction
35
36. Gingivectomy
■ Laser offers increased operator control & minimal damage in the removal of
gingival tissue for restorative purpose & gingival hyperplasia.
■ Pick RM et al presented 12 cases of phenytoin hyperplasia removed
surgically by the CO2 lasers & hence suggested that in the future the laser
may offer an alternative or an advancement to current procedures now used
in dentistry.
Pick RM, Pecaro BC & Silberman CJ (1985) the laser gingivectomy : the use of CO2 laser for the
removal of phenytoin hyperplasia. Jop 56, 492-6
36
37. Crown lengthening
■ Lasers have been used for clinical crown lengthening without flap
reflecting for both esthetic & prosthetic reasons.
■ Cobb CM et al only support such application in non controlled case
reports.
Cobb CM (2006). Lasers in periodontics: a review of the literature. Jop 77, 545 - 64
37
38. Frenectomy
■ According to Kafas P et al. 2009, diode laser frenectomy maybe performed
without infiltrated anesthesia with the optimum healing post surgically.
Tissue pigmentation reduction
■ Recently, laser has been used widely & is even preferred over scalpel
technique procedure for depigmentation.
38
39. Implant therapy- management of peri implantitis
■ Peri-implantitis management options:
■ Conventional – plastic curette & antibiotics
■ Newer option – Laser
■ Rationale :
• Disinfection & decontamination of implant surface
• Granulation tissue removal
• laser used : Diode, Erbium, CO2,
• Laser not used : Nd YAG
39
40. Authors & year Lasers used Study
design
Objective Findings
Schwarz et al
2006
Er YAG c/l & h/l Pocket
debridement &
decontamination
c/l improvement at the end
of 6 mnths of therapy
similar to conventional
therapy
Deppe et al
2001
CO2 invivo decontamination Safe for debridement of
bone defect around
implants
Schwarz et al
2006
Er YAG invivo Granulation tissue
removal
Laser btr than plastic
instruments & antibiotics/
ultrasonic scalers
40
41. Photo dynamic therapy
■ Main objective: to eliminate deposits of bacteria
■ Conventional methods incomplete because of :
Anatomic complexity of root
Deep periodontal pockets
41
42. Photodynamic reaction
Principle
■ Only the first excited state with the
energy of 94 kJ/mol (22 kcal/mol)
above the ground state is important
and the second excited state does
not react.
42
43. Mechanism of action : PDT involves three components: light, a
photosensitizer, and oxygen.
When a photosensitizer is administered to the patient and irradiated with a
suitable wavelength, it goes to an excited state from its ground state. This
excited state can then decay back to its ground state or form the higher
energy triplet state.
The triplet state photosensitizer can react with biomolecules in two different
pathways - type I and II
43
44. ■ Type I: It involves electron/hydrogen transfer directly from the
photosensitizer, producing ions, or electron/hydrogen removal from a
substrate molecule to form free radicals.
■ These radicals react rapidly with oxygen, resulting in the production of
highly reactive oxygen species (superoxide, hydroxyl radicals, and hydrogen
peroxide).
44
45. ■ Type II: In type II reaction, the triplet state photosensitizer reacts with oxygen
to produce an electronically excited and highly reactive state of oxygen, known
as singlet oxygen ( 1 O2 ) which can interact with a large number of biological
substrates inducing oxidative damage on the cell membrane and cell wall.
■ Microorganisms that are killed by singlet oxygen include viruses, bacteria, and
fungi. Singlet oxygen has a short lifetime in biological systems and a very short
radius of action (0.02 mm).
■ Hence, the reaction takes place within a limited space, leading to a localized
response; thus making it ideal for application to localized sites without affecting
distant cells or organs. Thus, the type II reaction is accepted as the major
pathway in microbial cell damage.
45
46. ■ The effectiveness of cellular targeting of the photosensitizer is also affected by
heterogenous perfusion, vascular permeability, and interstitial pressure of the
tumor (Chen B et al., 2005; Solban et al., 2006).
■ PDT produces cytotoxic effects through photodamage to subcellular organelles
and molecules. Mitochondria, lysosomes, cell membranes, and nuclei of tumor
cells are considered potential targets, along with the tumor vasculature.
■ During light exposure, sensitizers that localize in mitochondria may induce
apoptosis, while sensitizers localized in lysosomes and cell membranes may
cause necrosis (Castano et al., 2005).
46
47. Light Sources
■ PDT requires a source of light that activates the photosensitizer by exposure to
low-power visible light at a specific wavelength. Human tissue transmits red
light efficiently, and the longer activation wavelength of the photosensitizer
results in deeper light penetration.
■ Consequently, most photosensitizers are activated by red light between 630 and
700 nm, corresponding to a light penetration depth from 0.5 cm (at 630 nm) to
1.5 cm (at ~ 700 nm) (Salva, 2002; Kübler, 2005). This limits the depth of
necrosis and/or apoptosis and defines the therapeutic effect
47
48. The total light dose, the dose rates, and the depth of destruction vary with
each tissue treated and with each photosensitizer (Grant et al., 1997; Biel,
2002; Allison et al., 2005, 2006)
48
49. ■ In the past, photosensitizer activation was achieved via a variety of light
sources, such as argon-pumped dye lasers, potassium titanyl phosphate (KTP)-
or neodymium:yttrium aluminum garnet (Nd/YAG)-pumped dye lasers, and
gold vapor or copper vapor-pumped dye lasers.
■ All these laser systems are complex and expensive.
■ At present, diode laser systems that are easy to handle, portable, and cost-
effective are used predominantly (Kübler, 2005). For treatment of larger areas,
non-coherent light sources, such as tungsten filament, quartz halogen, xenon
arc, metal halide, and phosphor-coated sodium lamps, are in use.
49
50. ■ Recently, non-laser light sources, such as light-emitting diodes (LED), have also
been applied in PDT (Allison et al., 2004c; Juzeniene et al., 2004; Pieslinger et
al., 2006; Steiner, 2006).
■ These light sources are much less expensive and are small, lightweight, and
highly flexible.
50
51. Photosensitizers
Thousands of natural and synthetic photoactive compounds have
photosensitizing potential.
They include degradation products of chlorophyll, polyacetylenes,
thiophenes, quinones (cercosporin), anthraquinones (fagopyrin, hypericin),
and 9- methoxypsoralen (Ebermann et al., 1996).
An ideal photosensitizer should be non-toxic, and should display local
toxicity only after activation by illumination. The majority of the sensitizers
used clinically belong to dyes, the porphyrinchlorin platform, and
furocoumarins
51
53. Photosensitizers used in the
different clinical applications of
photodynamic therapy (PDT) and
photodynamic antimicrobial
chemotherapy (PACT).
53
54. Side-effects
The major side-effect after the use of intravenous photosensitizers is
photosensitivity. photosensitizer can be activated by daylight, causing first-
or second-degree burns.
Usually, PDT treatment by itself is not painful, but several hours after PDT,
most patients suffer from severe pain. Pain medications should be given after
or prior to the laser treatment. Patients treated by topically applied ALA (5-
aminolevulinic acid) report burning sensations during illumination.
54
55. ■ PDT can cause burns, swelling, pain, and scarring in nearby healthy tissues.
Other side-effects of PDT are related to the area that is treated. They can
include coughing, trouble swallowing, stomach pain, painful breathing, or
shortness of breath; these side-effects are usually temporary.
■ All other potential side-effects, such as allergic reaction, change of liver
parameters, etc., occur infrequently and are specific for each
photosensitizer and each patient (Vrouenraets et al., 2003; Kübler, 2005).
55
58. Allison et al. have described PDT as the therapy that “is truly the
marriage of a drug and a light,” and as a result, only interdisciplinary
research approaches can overcome all the difficulties and challenges of
PDT.
58
59. Effects of Lasers on Periodontal Therapy (Summarize)
■ Pain relief
• Laser therapy blocks the pain signals transmitted from injured parts of the
body to the brain. This decreases nerve sensitivity and significantly reduces
the perception of pain.
• Increases the production and release of endorphins and enkephalins
which are natural pain-relieving chemicals within our bodies.
59
60. ■ Inflammation reduction
• Laser therapy causes the smaller arteries and lymph vessels of the body to
increase in size – a mechanism called vasodilatation.
• This increased vasodilatation more effectively allows the following:
• Inflammation, swelling, and edema to be cleared away from injury sites.
• Promotes lymphatic drainage which also aids in this vital healing process.
Accelerated tissue repair and cell growth
• Photons of light emitted by therapeutic lasers penetrate deeply into the tissues
of the body to stimulate the production centers of individual cells.
60
61. Wound healing
Improved blood flow
Laser therapy significantly increases the formation of new capillaries (tiny blood vessels)
within damaged tissues.
Reduced formation of scar tissue
• Laser therapy reduces the formation of scar tissue (fibrous tissue) following tissue damage
related to cuts, burns, and surgery.
• Laser therapy is able to reduce this formation by speeding up the healing process,
improving the blood flow to the injured area, and more effectively carrying away waste
products.
• Faster healing always leads to less scar tissue formation.
Raffetto N. Lasers for initial periodontal therapy. Dent Clin N Am 2004;48:923-36.
61
62. Conclusion
The application of lasers has been recognized as an adjunctive or alternative
approach in soft tissue surgeries.
Laser t/t have been shown to be superior to conventional mechanical
approaches with easy ablation, decontamination and hemostasis, as well as
less surgical and postop pain in soft tissue management.
62
63. References
Jha A, Gupta V, Adinarayan R. LANAP, periodontics and beyond: a review. J Lasers Med Sci.
2018;9(2):76- 81. doi:10.15171/jlms.2018.16.
Dr. Rao Naman Rajeshkumar and Dr. Chandramani B. More proposed classification” IJOCR
8,09, 38985-38994
ARCHANA V. Calculus detection : where we stand now ? Journal of Medicine and Life
Volume 7, Special Issue 2, 2014
Prabhuji Munivenkatappa Lakshmaiah et al. NOVEL SYSTEMS FOR CALCULUS DETECTION
AND REMOVAL- A REVIEW .
Konopka & Goslinski. Photodynamic Therapy in Dentistry. J Dent Res 86(8) 2007.
Kumar V, Sinha J, Verma N, Nayan K, Saimbi CS, Tripathi AK. Scope of photodynamic
therapy in periodontics. Indian J Dent Res 2015;26:439-42
63
64. Charles M Cobb. Lasers in Periodontics: A Review of the Literature. J Periodontol
2006;77:545-564.
Elavarasu S, Naveen D, Thangavelu A. Lasers in periodontics. J Pharm Bioall Sci
2012;4:260-3.
Offenbacher S. Periodontal diseases: Pathogenesis. Ann Periodontol 1996;1:821-
78.
Raffetto N. Lasers for initial periodontal therapy. Dent Clin N Am 2004;48:923-36.
Piccione PJ. Dental laser safety. Dent Clin North Am 2004;48:795-807.
Powell GL, Morton TH, Whisenant BK. Argon laser oral safety parameters for
teeth. Lasers Surg Med 1993;13:548-52.
Walsh LJ. The current status of laser applications in dentistry. Aust Dent J
2003;48:146-55.
64
65. Diode laser – initiation
■ Diode laser fibers are "initiated" by burning articulating paper on the tip. This
initiation causes the light energy to be absorbed by the burnt material on the
tip, effectively making it a hot piece of quartz. The laser energy cuts indirectly
by heating up the fiber optic tip. Diose lasers do not have enough peak
power to efficiently cut tissue on their own without initiation.
■ If one defines "laser dentistry" as light interacting with tissue, then diode
procedures are not laser dentistry ones.
■ Biolase : Pre initiated tips
65
66. Laser fumes : Gases
Poly cyclic aromatic hydrocarbons
Hydrogen cyanide & benzene
Heavy metals
Formaldehyde & synthetic fibers
Acute Health attack to long term asthma or nervous system damage
66